WEBVTT
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JOY LAWN: Now we move onto,
why do newborn deaths occur?
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Now part of the
problem for newborns
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is that the global pie chart
for causes of child death--
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which was used until as recently
as 2005-- totally hid newborns.
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So if you look at
this pie chart--
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and in epidemiology 101 we
learn that any pie chart where
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'other' is the biggest slice
is not a useful pie chart--
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and in this pie chart, between
'other' and 'perinatal causes',
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are around 36% of deaths
happening in the neonatal
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period, without clearly defined
causes that can be addressed.
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And perinatal causes is just
what happens to be in the WHO
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ICD-10 chapter
called 'P causes'.
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So it's some codes,
specific codes,
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for neonatal cause of
death, but isn't something
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that the average policy
maker understands
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looking at this pie chart.
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So until relatively
recently, it's not surprising
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that either the
proportion of deaths
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that were neonatal-- It's not
surprising that it wasn't clear
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what proportion of
deaths were neonatal,
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but also, it wasn't
clear that there
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were programmatic and
addressable causes.
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So moving forward
and leaping lightly
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through about four years
of very painful analysis,
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a pie chart, at
global level, was
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published in The Lancet
Neonatal Series in 2005,
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and also in the World Health
Assembly report that year.
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And this pie chart took
estimates from 195 countries
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and was able to split out
the causes, programmatically
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relevant causes, of neonatal
deaths within this time period.
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And as we have moved
forward, WHO have carried on,
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leading those estimates with
academics working with them,
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many from The London
School involved in this.
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And generating estimates for
under five deaths each year,
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by each country, also
with neonatal deaths.
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And these estimates
show that around 44%,
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in fact more than that
now, of child deaths
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are in the neonatal period.
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And in this nicely yellow,
jaundice looking slice,
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we can see there
are specific causes.
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And the leading cause
of not just newborn
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deaths, but child deaths, is
now preterm complications.
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Now this is a critical message.
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So, if you speak to the average
high level policy maker,
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including some eminent
global philanthropists who
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fund a lot of this work,
such as Bill Gates,
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and say, what are the main
causes of child death,
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most of them will
still say infections.
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They'll tell you about
malaria, or HIV, vaccines.
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And we're going to be
studying next week,
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about infectious diseases.
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And because of great
progress in reducing
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these, still an unfinished
agenda but great progress,
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a lack of progress in this
time period, more of the deaths
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are in the neonatal period.
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And particularly,
preterm birth, which
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has had one of the
slowest rates of change,
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is now the leading overall
cause of child deaths.
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And this signifies a transition.
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An epidemiological
transition for the child,
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particularly, where infectious
diseases still remain.
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But shifting not just to deaths
within the neonatal period,
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but to ones where we have to
do something differently also,
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with maternal health through
the life cycle and care.
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The other leading causes here,
intrapartum related events,
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what used to be
called birth asphyxia.
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So birth asphyxia simply
means not breathing at birth,
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can also happen because
you're extremely preterm.
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And what we're
trying to do here is
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to split out those
term babies that
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have a hypoxic related
intrapartum event.
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And then there's
a large slice here
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if you put the
infections together,
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particularly the
pneumonia, the sepsis,
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and some of the other
syndromes where-- we're just
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grouping this as a
syndromic diagnosis,
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and we really need to be able
to move to much better studies
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looking at aetiology.
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And better reporting
and analysis of this
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is critical and is
something that is raising up
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the global agenda.
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So these are the current
causes of neonatal deaths,
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showing a really critical
piece of information
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that's, actually,
poorly understood still
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at higher level policy.
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But if we look at how this
varies around the world,
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so what this stacked
bar chart shows
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you is on the left hand
side, all the countries
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that have a neonatal mortality
rate of less than five.
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And this is basically
industrialised countries.
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Going through to
the right hand side
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with all the countries that
have a neonatal mortality
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rate of more than 30.
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So this is predominantly
in Sub-Saharan Africa
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and south Asia.
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And looking at this,
it's very clear
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that while preterm birth is
still the leading cause in each
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of these places, so the pink
and the purple bar in the middle
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here is still the biggest
group, but the proportion
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that are attributed to
infections is very different.
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So in high mortality
settings, we still
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have many babies who
are dying needlessly
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from lack of prevention
of infection,
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so clean birth, breastfeeding,
and so on, but also treatment.
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So giving antibiotics
to these babies,
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identifying them, treating
them, and providing
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the antibiotic and supportive
care that are needed.
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And this is the single
biggest disparity
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across the neonatal period
for cause-specific mortality.
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A 30 fold risk in dying
from neonatal sepsis
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if you're in a rich country,
through to these lower
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income, lower resource settings,
and this is the first thing
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we should be acting on.
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Tetanus has made remarkable
progress, not just
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because we have an
immunisation, but because data
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has been used to ensure that
every district is reached
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with that immunisation target.
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So not only knowing
what the causes are,
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but having the data to
be able to drive coverage
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is really critical.
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So this is variation in
causes of neonatal mortality,
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but I want to
underline, particularly,
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this survival gap.
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So around the world, if you
take a preterm baby, over 90%
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of preterm babies
less than 28 weeks
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will survive in a high
income country, even
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less than 25 weeks.
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But if we go to a low income
setting, less than 10% of these
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are surviving.
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And this isn't just
about intensive care.
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It's about the lack
of effective care
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of small and sick
newborns: warmth,
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feeding support, prevention
and management of infections.
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